American Academy of Pediatrics: Benefits of Circumcision Outweigh Risks

At the risk of provoking the ire of anti-circumcision zealots (you know who are), I thought I’d mention that the American Academy of Pediatrics, reversing a previous neutral stance, is now endorsing male circumcision based on a review of recent scientific evidence.

I undertook a reasonably thorough review of the existing evidence myself, frankly with a bias toward finding that circumcision was overall harmful. I was aware that circumcision, like several other medical procedures (think episiotomy during childbirth) was encouraged for decades by an unthinking medical establishment that didn’t undertake the research needed to support its recommendations. I was perfectly willing to believe that circumcision had few if any health benefits, had significant costs, and should be done only for religious reasons if at all.

I couldn’t find such evidence. Instead, I found that it has small but real health benefits, and that there is no sound evidence of reduced sexual function (I know, tons of nerve endings, blah blah blah, but where is the evidence that on average it makes sex less enjoyable? Studies on men circumcised as adults don’t provide such evidence). I’m not sure that would be enough to lead me to circumcise my own son (mostly because of squeamishness) [if I weren’t Jewish, and had a son], but I think it’s an easy call if you plan to raise your son Jewish; the last thing you want is for your kid to decide at age 20 or whatever that his religion demands circumcision, and to have to undergo it then, when the risks and pain are much worse. (If there was sound evidence of harm from circumcision, that would be a different story).

The “right to bodily integrity” argument so popular in Europe these days doesn’t sway me. What if your kid is born with six fingers, or with an ugly mole on his face, neither of which are causing harm beyond the aesthetic, and removal of either of which will cause some pain? Does his “right to bodily integrity” mean that you have to wait until he’s sixteen to let him decide whether to remove the appendage? Those strike me as harder cases than circumcision, given that circumcision actually provides some medical benefits. But I think it would be absurd to ban, or even discourage, removal.

If there was sound evidence that circumcision was affirmatively harmful, I think governments (and busybodies) would have every right to discourage it, including by law for minors, regardless of religious sensitivities. Given that the evidence points in the opposite direction, the movement in Germany and elsewhere to ban circumcision is unconscionable.

UPDATE: Two more points, one from the study, one not. A lot of old-fashioned mohels refuse to use even topical anesthesia, even though there is no halachic (Jewish law) prohibition on doing so. The study says quite strongly that either a topical anesthetic or a penile nerve block should be used. On the other hand, I’d be wary of having a circumcision done in a hospital, absent some real investigation of who is doing the procedure. My physician family members tell me that most doctors hate doing circumcisions, and if you do it in the hospital the more experienced doctors will order the much less experienced residents or interns to do it. Not surprisingly, the report, while not noting this, points out that physicians doing the procedure should be properly trained. Best bet, imho: a physician who is also a trained mohel.